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中华介入放射学电子杂志 ›› 2020, Vol. 08 ›› Issue (02) : 170 -174. doi: 10.3877/cma.j.issn.2095-5782.2020.02.014

所属专题: 文献

影像诊断

XperCT辅助PTCD精准治疗恶性梗阻性黄疸的临床应用研究
李善凯1, 胡效坤2,()   
  1. 1. 266000 山东青岛,青岛大学研究生院
    2. 青岛大学附属医院介入医学中心
  • 收稿日期:2020-02-17 出版日期:2020-05-25
  • 通信作者: 胡效坤

XperCT-assisted PTCD for accurate treatment of malignant obstructive jaundice

Shankai Li1, xiaokun Hu2,()   

  1. 1. Graduate School of Qingdao University, the Affiliated Hospital of Qingdao University, Shandong Qingdao 266000, China
    2. Interventional Medical Center, the Affiliated Hospital of Qingdao University, Shandong Qingdao 266000, China
  • Received:2020-02-17 Published:2020-05-25
  • Corresponding author: xiaokun Hu
  • About author:
    Corresponding author: Hu xiaokun, Email:
引用本文:

李善凯, 胡效坤. XperCT辅助PTCD精准治疗恶性梗阻性黄疸的临床应用研究[J/OL]. 中华介入放射学电子杂志, 2020, 08(02): 170-174.

Shankai Li, xiaokun Hu. XperCT-assisted PTCD for accurate treatment of malignant obstructive jaundice[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2020, 08(02): 170-174.

目的

探讨XperCT技术在恶性梗阻性黄疸经皮肝穿刺胆道引流术(percutaneous transphepatic cholangial drainage,PTCD)中提高手术精确性的临床应用价值。

方法

选择我院2018年10月至2019年10月期间恶性梗阻性黄疸87例,按照随机数字表法将87例患者分为两组,A组(42例),PTCD术中行XperCT检查;B组(45例),PTCD术中不行XperCT检查。采用t检验、χ2检验,比较两组首次穿刺目标胆管成功率(术前拟穿刺的段级胆管)、成功规避重要器官率(包括肝内肿瘤)、穿刺次数及时间、暴露辐射剂量及术后并发症(出血、胆汁瘘、胰腺炎、感染等)。

结果

两组均穿刺成功,首次穿刺目标胆管成功率:A组达到88%,B组51%,P<0.05有统计学意义;成功规避重要器官率,A组可95%规避,B组78%(1例穿刺肿瘤大出血死亡),P=0.018,差异有统计学意义;穿刺时间及次数,A组(14.02±3.23)s、(1.09±0.29)次,B组(63.20±6.22)s、(1.75±0.90)次。暴露辐射剂量A组(6.21±1.35)mGy、B组(21.33±7.38)mGy,术后并发症(出血、感染,胆汁瘘、胰腺炎等),A组(0.07±0.26)例,B组(0.17±0.38)例,以上A组均优于B组,P<0.05,差异有统计学差异。

结论

XperCT在PTCD中加以应用可以弥补单一透视的不足,指导介入医师实施精确治疗,同时避免严重并发症的发生,最终改善PTCD治疗效果。

Objective

To explore the clinical application value by using XperCT technology to improve the accuracy in percutaneous transhepatic biliary drainage (PTCD) of malignant obstructive jaundice.

Methods

Eighty-seven cases with malignant obstructive jaundice from October 2018 to October 2019 in our hospital were enrolled.All patients were divided into two groups according to the random number table method. Forty-two cases as Group A were underwent XperCT examination during PTCD. Forty-five cases as Group B had no XperCT examination during PTCD. t test and χ2 test were used to compare the success rate of first puncture of target bile duct (segmental bile duct to be punctured before operation), the rate of successful avoidance of important organs (including intrahepatic tumor), number and time of puncture, radiation exposure dose and postoperative complications (hemorrhage, bile fistula, pancreatitis, infection, etc.) between the two groups.

Results

Both groups were punctured successfully. The success rate of the first puncture of the target bile duct were 88% in group A and 51% in group B with significant difference (P<0.05). The success rate of avoiding important organs were 95% in group A and 78% in group B (1 case died of massive hemorrhage from puncture tumor) with significant difference (P=0.018), the number and time of puncture, radiation dose , postoperative complications (hemorrhage, infection, bile fistula, pancreatitis, etc.) were 14.02±3.23 s, 1.09±0.29 times, 6.21±1.35 mGy, 0.07±0.26, in group A respectively, and 63.20±6.22, 1.75±0.90 times. 21.33±7.38 mGy, 0.17±0.38, in group B respectively, and the group A was superior to group B.

Conclusions

The application of XperCT in PTCD can make up for the deficiency of single fluoroscopy, guide interventional physicians to carry out accurate treatment, avoid the occurrence of serious complications, and ultimately improve the therapeutic effect of PTCD.

图1 1A、1B为患者MR图像,胆管恶性肿瘤并梗阻性黄疸,且合并肝内占位病变,T2WI及FLAIR见肝内囊性占位病变(术前)
图2 2A:XperCT拟好横断位穿刺路径、方向和深度,避开后方肝内占位;2B:冠状位显示穿刺路径、方向及深度,病变在其下方
图3 经导航穿刺成功后造影证实
图4 位术后3天复查CT评价手术效果
表1 两组数据比较
表2 两组数据比较
[1]
汤钊献.现代肿瘤学[M].上海:复旦大学出版社,2011: 14-28.
[2]
申宝忠.介入放射学[M].北京:人民卫生出版社,2012: 81-82.
[3]
郑琳,郭晨阳,黎海亮,等.C臂CT在经皮经肝胆道引流术治疗梗阻性黄疸中的应用[J].介入放射学杂志,2013, 22(12): 1007-1010.
[4]
Yang F, Jin C, Zou C, et a1. Delaying surgery after preoperative biliary drainage does not increase surgical morbidity after pancreaticoduodenectomy[J]. Surgery, 2019, 166 (6): 1004-1010.
[5]
朱光宇,滕皋军,郭金和,等.联合运用超声及X线引导穿刺在恶性胆道梗阻介入治疗中的应用[J].中国医学影像技术,2010, 26(12): 2360-2363.
[6]
肖运平,刘惕生,许彪,等.C臂CT在腹部介入诊疗中的初步应用[J].介入放射学杂志,2011, 20(5): 410-413.
[7]
Pedicelli A, Verdolotti T, Pompucci A,et a1.Interventional spinal procedures guided and controlled by a 3D rotational angiographic unit[J]. Skeletal Radiol, 2011, 40(12): 1595-1601.
[8]
Tam AL, Mohamed A, Pfister M, et a1. C-arm cone beam computed tomography needle path overlay for fluoroscopic guided vertebroplasty[J]. Spine (Phila Pa 1976), 2010, 35 (10): 1095-1099.
[9]
Kim GH, Ryoo SK, Park JK, et a1. Risk factors for pancreatitis and cholecystitis after endoscopic biliary stenting in patients with malignant extrahepatic bile duct obstruction[J]. Clinical Endoscopy, 2019, 52(6): 598-605.
[10]
钱晓军,戴定可,翟仁友,于平,等.经皮肝穿胆汁引流术后胆道出血的临床分析[J].介入放射学杂志,2007, 16(10):702-704.
[11]
Nanashima A, obdgAbo T, Sakamoto I, et a1. Three-dimensional cholangiography applying C-arm computed tomography in bile duct carcinoma: a new radiological technique[J]. Hepatogastroenterology, 2009, 56(91-92): 615-618.
[12]
Krohmer SJ, Pillai AK, Guevara CJ, et al. Image-guided biliary interventions: how to recognize, avoid, or get out of trouble[J]. Techniques in Vascular and Interventional Radiology, 2018, 21(4): 249-254.
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